The Hits Keep Coming

I hope this blog’s readers are enjoying their Memorial Day weekend if they’re in the U.S., or their Spring Bank Holiday weekend if in the U.K.   And if I’m unaware that there is another three-day weekend being celebrated out there, please forgive my myopia.  I do believe it was last weekend that my friends in Canada were enjoying the Victoria’s Day weekend, but this week brings a standard two days off.  However, if I have confused my holidays, again, I submit my humble apologies!

Wembley Stadium, London. Site of 2013 Champions League Final.

I suspect a lot of you are watching the all-German Champions League final right now, or perhaps you’re napping and waiting for the start of the French Open tomorrow. Maybe it’s the Indy 500 on Monday you’re waiting for…..or, speaking of Indy, you’re hoping for another Pacers upset of the Heat in the NBA playoffs. Regardless, here’s to a great sporting weekend!

I wanted to look at an interesting article from the most recent edition of CJSM in this weekend’s blog post…..which I learned today is something quite different from a blog.  Apparently there is a blogger posting at Slate about his irritation over the misuses of the word ‘blog’ and the phrase ‘blog post.’  It turns out that right now you are visiting the CJSM ‘blog’ but are reading a ‘blog post’ entitled, “The Hits Keep Coming.”  Please do pass this “blog post” on to your friends, and recommend they visit our “blog,” but do not mix up your phrasing or the Slate editor might make you a focus of one of his future rants.

I suspect his irritation might resemble mine, or some of this blog’s (???) readers, when folks mix up ‘incidence’ and ‘prevalence,’ so I want to grant that his irritation may be righteous and I will try my level best as I work on my posts to use correct blog terminology!

The Rocky Mountains: it’s hard to plug one’s ears to their siren’s call.

On to the article of the weekend: “Epidemiology of U.S. High School Sports-Related Ligamentous Ankle Injuries, 2005/06 – 2010/11,” written by a group including my friends R. Dawn Comstock, PhD.,  the senior author, and Christy Collins, MA., the corresponding author.  This team has been prolific in their publication of sports medicine epidemiology articles, drawing much of their work from the high school injury surveillance project, “Reporting Information on Line” (RIO): “….an internet-based surveillance software developed under the direction of Dr. Dawn Comstock.”  I had the privilege of working with Dawn at my home base, Nationwide Children’s Hospital until recently, when the lure of the Rocky Mountains drew her to the University of Colorado, Denver.

The hits I’m referring to in this, um, blog post’s title are the ones that Dr. Comstock and her crew, including Christy Collins, keep pumping out in journals like ours.  Just in CJSM in recent years Dr. Comstock has looked at issues ranging from the use of protective equipment in female rugby players to the rates of dislocation injuries in U.S. high school sports.

The May 2013 CJSM article–which in addition to Dr. Comstock and Christy Collins has as its  first author David Swenson, MD, MPH  and its other contributing author Sarah Fields, JD, PhD,  both from my home base of Columbus, Ohio–focuses on ankle injury rates in American high school athletes.  The study group reported on six years worth of data, with 5373 ankle injuries included, so we’re talking ‘big data’ here.

Some of the results of this study were confirmatory of my clinical experience–or, perhaps a better way of putting that, is that my a priori expectations based on my clinical experience were confirmed by the evidence put forth in this well-designed epidemiologic study. For instance, not surprisingly the study group found that the most commonly injured ligament of the ankle is the anterior talofibular ligament (ATFL), involving 85.3% of all sprains.  In addition, essentially half of the ankle sprains resolved withing a week:  49.7% of all sprains resulted in loss of participation from 1 to 6 days.

A bad day at the office….

What was news for me included the exact rates at which high school athletes injured their ankles:  3.13 ankle sprains per 10,000 athlete exposures.  In addition I noted the interesting findings that ankle injury rates were higher for girls–95% confidence interval (CI) for a rate ratio (RR) (1.17 – 1.34)–for gender-comparable sports and rates of ankle injury rates essentially trebled when comparing competition to practice settings.

I greatly enjoy such injury studies as I reflect on them frequently when I am in the clinic setting.  For instance, one article I come back to time and again is the large, randomized controlled trial in 2011 providing definitive evidence for the beneficial effect of lace-up ankle braces in reducing rates of ankle injuries: “The Effect of Ankle Braces on Injury Rates in High School Basketball Players.”  It was not that long ago when I might be in a room with a patient and family and answering their questions about ankle braces with a comment to the effect that’ it’s worth a try’.  The 2011 study has changed the dynamic of the discussion I have in such a setting, as I am much more apt to be prescriptive in the use of such braces.

The joys of Evidence-based medicine!  Perhaps not quite as scintillating as a well-played football match (I just peeked, it’s 1 -1 in the 80th minute…..), but to those of us who practice clinical sports medicine, studies like the one authored by Drs. Swenson and Comstock provide us a certain sangfroid.

Enjoy your weekend, whether it’s the two-day or an extended version.  I’m heading off to the annual meeting of the American College of Sports Medicine next week, so I’ll be blogging (?blog posting)  from there.  If you’re heading to Indy too, give a shout out to us on twitter @CJSMonline, #ACSMannualmtg or better yet, flag me down and say hi.